Provider Demographics
NPI:1023297090
Name:CORNERSTONE CHIROPRACTIC, P C
Entity type:Organization
Organization Name:CORNERSTONE CHIROPRACTIC, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:317-745-7700
Mailing Address - Street 1:5250 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9199
Mailing Address - Country:US
Mailing Address - Phone:317-745-7700
Mailing Address - Fax:317-745-1230
Practice Address - Street 1:5250 E US HIGHWAY 36
Practice Address - Street 2:SUITE 140
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9199
Practice Address - Country:US
Practice Address - Phone:317-745-7700
Practice Address - Fax:317-745-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU44689Medicare UPIN
IN343860Medicare Oscar/Certification